title: Simulation to assess the safety of new healthcare teams and new facilities.
abstract: BACKGROUND
  : Our institution recently opened a satellite hospital including a pediatric emergency department. The staffing model at this facility does not include residents or subspecialists, a substantial difference from our main hospital. Our previous work and published reports demonstrate that simulation can identify latent safety threats (LSTs) in both new and established settings. Using simulation, our objective was to define optimal staff roles, refine scope of practice, and identify LSTs before facility opening.
  
  
  METHODS
  : Laboratory simulations were used to define roles and scope of practice. After each simulation, teams were debriefed using video recordings. The National Aeronautics and Space Administration-Task Load Index was completed by each participant to measure perceived workload. Simulations were scored for team behaviors by video reviewers using the Mayo High Performance Team Scale. Subsequent in situ simulations focused on identifying LSTs and monitoring for unintended consequences from changes made.
  
  
  RESULTS
  : Twenty-four simulations were performed over 3 months before the hospital opening. Laboratory debriefing identified the need to modify provider responsibilities. National Aeronautics and Space Administration-Task Load Index scores and debriefings demonstrated that the medication nurse had the greatest workload during resuscitations. Modifying medication delivery was deemed critical. Lower Mayo High Performance Team Scale scores, implying less teamwork, were noted during in situ simulations. In situ sessions identified 37 LSTs involving equipment, personnel, and resources.
  
  
  CONCLUSIONS
  : Simulation can help determine provider workload, refine team responsibilities, and identify LSTs. This pilot project provides a template for evaluation of new teams and clinical settings before patient exposure.
authors.affiliation: From the Division of Emergency Medicine, Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. gary.geis@cchmc.org
authors.forename: Gary L
authors.initials: GL
authors.lastname: Geis
authors.forename: Brian
authors.initials: B
authors.lastname: Pio
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Pendergrass
authors.forename: Michael R
authors.initials: MR
authors.lastname: Moyer
authors.forename: Mary D
authors.initials: MD
authors.lastname: Patterson
mesh_terms: D002983:Clinical Competence; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006126:Group Processes; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration*; D010865:Pilot Projects; D011446:Prospective Studies; D017751:Safety Management / Q000458:organization & administration*; D013647:Task Performance and Analysis; D016526:Workload